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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371250
Report Date: 09/16/2019
Date Signed: 09/16/2019 11:13:25 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CANYON HILLS CHILDCARE/CANYON HILLS FRIENDS CHURCHFACILITY NUMBER:
304371250
ADMINISTRATOR:RICE, SHARLENEFACILITY TYPE:
850
ADDRESS:20400 FAIRMONT CONNECTORTELEPHONE:
(714) 695-0100
CITY:YORBA LINDASTATE: CAZIP CODE:
92866
CAPACITY:36CENSUS: 11DATE:
09/16/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Sharlene Rice, Director TIME COMPLETED:
11:45 AM
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A case management inspection was conducted by Licensing Program Analyst (LPA) Port and LPA Chan to re-evaluate measurements obtained on 09/10/2019. An amended report dated 09/10/2019 was issued.

Upon arrival LPA's met with Director Sharlene Lewis who guided LPAs on a tour of the facility. LPAs observed 7 preschool age children and 2 staff members in Room 104 and 4 toddlers and 1 staff member on the outdoor play area. During the inspection it was determined that the facility was operating within its licensed capacity and within compliance of staffing ratios. A review of staff records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearance or exemption and a child abuse index clearance.

There no Title 22 deficiencies cited during today's inspection.

Exit interview was conducted with Director, Sharlene Lewis. Report reviewed and discussed. Notice of Site Visit was posted during the visit. Facility representative was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Appeal rights provided and explained. The facility representative was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. Facility representative was informed of how/where to access regulations and forms from CCLD website: www.ccld.ca.gov
SUPERVISOR'S NAME: Rina LopezTELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Wendy PortTELEPHONE: (714) 293-9315
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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